What are the primary uses of Chlorhexidine Gluconate for oral health. How effective is this antimicrobial agent in preventing mouth infections. What precautions should be taken when using Chlorhexidine Gluconate oral rinse.

Understanding Chlorhexidine Gluconate: A Powerful Oral Antimicrobial Agent

Chlorhexidine Gluconate is a widely used antimicrobial agent in dentistry and oral care. This potent compound has gained significant attention for its effectiveness in combating various oral health issues. But what exactly is Chlorhexidine Gluconate, and how does it work?

Chlorhexidine Gluconate is a chemical antiseptic that works by disrupting the cell membranes of bacteria and other microorganisms. Its broad-spectrum activity makes it effective against a wide range of oral pathogens, including those responsible for gum disease and tooth decay.

The Science Behind Chlorhexidine’s Effectiveness

The effectiveness of Chlorhexidine Gluconate lies in its unique molecular structure. How does this structure contribute to its antimicrobial properties? The positively charged Chlorhexidine molecules are attracted to the negatively charged bacterial cell walls. This attraction leads to the disruption of the cell membrane, causing the bacteria to lose vital cellular components and ultimately die.

Moreover, Chlorhexidine has a remarkable ability to bind to oral tissues, including teeth and mucous membranes. This property, known as substantivity, allows the compound to remain active in the mouth for extended periods, providing prolonged protection against bacterial growth.

Primary Uses of Chlorhexidine Gluconate in Oral Care

Chlorhexidine Gluconate finds application in various oral health scenarios. Its versatility makes it a valuable tool in both preventive and therapeutic dental care. What are the main uses of this antimicrobial agent?

• Prevention of plaque formation and gingivitis
• Treatment of periodontal diseases
• Reduction of oral bacteria before and after dental procedures
• Management of oral infections and ulcers
• Maintenance of oral hygiene in patients with limited ability to perform mechanical plaque removal

One of the most common applications of Chlorhexidine Gluconate is in the form of an oral rinse. These rinses are typically prescribed by dentists for short-term use to address specific oral health issues or as part of a comprehensive treatment plan.

Effectiveness of Chlorhexidine in Preventing Mouth Infections

The efficacy of Chlorhexidine Gluconate in preventing and treating oral infections has been well-documented in numerous clinical studies. How effective is this antimicrobial agent in maintaining oral health?

Research has shown that Chlorhexidine oral rinses can significantly reduce plaque formation and gingivitis when used as directed. In one study, participants using a Chlorhexidine rinse twice daily for six weeks showed a 61% reduction in plaque and a 67% reduction in gingivitis compared to the control group.

Furthermore, Chlorhexidine has demonstrated effectiveness in reducing the risk of postoperative infections following oral surgery. Its use before and after dental procedures can help maintain a clean oral environment, promoting faster healing and reducing the likelihood of complications.

Real-World Effectiveness: User Experiences

While clinical studies provide valuable data, real-world experiences offer insights into the practical effectiveness of Chlorhexidine Gluconate. Many users report positive outcomes when using Chlorhexidine products as prescribed by their dentists.

One user with periodontitis shared their experience: “I have periodontitis and would brush and floss regularly, but my gums would still bleed. This was prescribed, and it has helped tremendously. I only have one tooth that bleeds a tad occasionally, and when I went to the dentist and they probed me, no bleeding. That was unheard of for me.”

Another user with Sjögren’s syndrome, a condition affecting saliva production, reported: “I have Sjögren’s Syndrome, and with loss of teeth due to no saliva production, the microbiotic properties of CHX works very well. When I get sores inside my mouth, they disappear usually overnight. I swear by this product, and I have been using this for the past ten years. It’s awesome.”

Potential Side Effects and Precautions of Chlorhexidine Use

While Chlorhexidine Gluconate is generally considered safe and effective, it’s crucial to be aware of potential side effects and take necessary precautions. What are the common side effects associated with Chlorhexidine use?

• Tooth staining
• Altered taste sensation
• Increased tartar formation
• Dry mouth
• Mouth irritation
• Allergic reactions (in rare cases)

It’s important to note that many of these side effects are temporary and resolve after discontinuing use. However, some users may experience more severe reactions. One user reported: “I was prescribed this after dental surgery. Within a week, I was experiencing dry mouth and tongue, irritated gums and tongue, mouth sores, dry and irritated red lips, and partial loss of taste. The side effects were outweighing the benefit.”

Precautions and Best Practices

To minimize the risk of adverse effects and maximize the benefits of Chlorhexidine Gluconate, consider the following precautions:

1. Use only as directed by your dentist or healthcare provider
2. Do not swallow the rinse
3. Avoid eating, drinking, or rinsing your mouth for at least 30 minutes after use
4. If you experience any unusual symptoms, discontinue use and consult your dentist
5. Inform your dentist of any allergies or sensitivities before using Chlorhexidine products

Chlorhexidine Gluconate in Comparison to Other Oral Antimicrobials

In the realm of oral antimicrobials, Chlorhexidine Gluconate stands out for its effectiveness. But how does it compare to other commonly used oral care products? Understanding these comparisons can help both dental professionals and patients make informed decisions about oral care regimens.

Chlorhexidine vs. Over-the-Counter Mouthwashes

Many over-the-counter mouthwashes contain active ingredients such as cetylpyridinium chloride, essential oils, or fluoride. While these products can be beneficial for daily oral hygiene, they generally don’t match the potency and long-lasting effects of Chlorhexidine Gluconate.

Chlorhexidine’s superior substantivity allows it to remain active in the mouth for up to 12 hours after use, providing extended protection against bacterial growth. This property makes it particularly effective for managing more severe oral health issues that may not respond adequately to regular mouthwashes.

Chlorhexidine vs. Antibiotics

In some cases, dentists may prescribe oral antibiotics to treat severe gum infections or abscesses. How does Chlorhexidine compare to these systemic treatments? While antibiotics work throughout the body to fight infections, Chlorhexidine acts locally in the mouth. This targeted approach can be advantageous in several ways:

• Reduced risk of systemic side effects
• Lower likelihood of contributing to antibiotic resistance
• Direct action on the site of oral infections

However, for deep-seated or systemic infections, antibiotics may still be necessary. The choice between Chlorhexidine and antibiotics (or a combination of both) depends on the specific clinical situation and should be made by a dental professional.

Innovative Applications of Chlorhexidine in Dentistry

As research in oral health continues to advance, new and innovative applications for Chlorhexidine Gluconate are emerging. These developments are expanding the utility of this versatile antimicrobial agent beyond traditional mouthwashes and rinses.

Chlorhexidine-Infused Materials

Dental researchers are exploring the incorporation of Chlorhexidine into various dental materials. For instance, Chlorhexidine-releasing adhesives and restorative materials are being developed to provide long-term antimicrobial protection in dental restorations. How might these innovations benefit patients?

• Reduced risk of secondary caries around fillings
• Extended protection against bacterial growth in hard-to-reach areas
• Potential for improved longevity of dental restorations

Chlorhexidine in Periodontal Therapy

In periodontal treatment, Chlorhexidine is being used in novel ways to enhance outcomes. Slow-release Chlorhexidine devices, such as chips or gels, can be placed directly into periodontal pockets, providing sustained antimicrobial action in these difficult-to-treat areas.

These localized delivery systems offer several advantages:

• Targeted treatment of specific problem areas
• Reduced need for systemic antibiotics
• Potential for improved healing in periodontal pockets

Managing Chlorhexidine Side Effects: Tips and Strategies

While Chlorhexidine Gluconate is highly effective, managing its potential side effects is crucial for patient comfort and compliance. What strategies can be employed to minimize these effects while maintaining the benefits of treatment?

Addressing Tooth Staining

One of the most common concerns with Chlorhexidine use is tooth staining. To manage this issue:

• Use Chlorhexidine rinses before bedtime to minimize exposure to staining agents
• Avoid consuming dark-colored foods and beverages for at least an hour after rinsing
• Maintain good oral hygiene practices, including regular brushing and flossing
• Consider professional teeth cleaning after completing the Chlorhexidine regimen

Dealing with Taste Alterations

Some users report changes in taste sensation when using Chlorhexidine. To mitigate this effect:

• Use the rinse after meals rather than before to minimize impact on food taste
• Rinse thoroughly with water after the prescribed waiting period
• If taste changes persist, consult your dentist about adjusting the concentration or frequency of use

Managing Dry Mouth

Chlorhexidine can sometimes cause or exacerbate dry mouth. To address this issue:

• Stay well-hydrated throughout the day
• Use sugar-free gum or lozenges to stimulate saliva production
• Consider using a saliva substitute if dryness persists
• Discuss with your dentist the possibility of using a lower concentration or alternating with other products

The Future of Chlorhexidine in Oral Health Care

As our understanding of oral health continues to evolve, so does the role of Chlorhexidine Gluconate in dental care. What does the future hold for this powerful antimicrobial agent?

Personalized Chlorhexidine Formulations

Researchers are exploring the development of personalized Chlorhexidine formulations tailored to individual patient needs. These customized products could potentially:

• Offer optimized concentrations based on specific oral health conditions
• Include complementary ingredients to enhance effectiveness or reduce side effects
• Provide targeted delivery systems for specific areas of the mouth

Integration with Digital Dentistry

As digital dentistry advances, the use of Chlorhexidine could be integrated into comprehensive treatment plans. For instance:

• Smart oral care devices could dispense precise amounts of Chlorhexidine based on real-time oral health data
• Teledentistry platforms might incorporate Chlorhexidine recommendations as part of remote oral health management
• AI-driven diagnostic tools could help optimize Chlorhexidine usage based on individual risk factors and treatment responses

Sustainability and Environmental Considerations

As environmental concerns grow, the future of Chlorhexidine in oral care may also involve addressing its ecological impact. Research into biodegradable formulations and eco-friendly packaging could help make Chlorhexidine use more sustainable.

In conclusion, Chlorhexidine Gluconate remains a cornerstone in oral antimicrobial therapy, with a proven track record of effectiveness in preventing and treating various oral health issues. As research continues and new applications emerge, this versatile compound is likely to play an increasingly important role in maintaining oral health and preventing dental diseases. However, it’s crucial to use Chlorhexidine products as directed by dental professionals and to be aware of potential side effects. With proper use and management, Chlorhexidine Gluconate can be a powerful tool in the pursuit of optimal oral health.

Effectiveness, Ease of Use, and Satisfaction

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Most voted positive review

25 People found this comment helpful

I was prescribed this after a dental surgery. Within a week I was experiencing dry mouth and tong, irritated gums and tong, mouth sores, dry and irritated red lips and partial loss of taste. The side effects were outweighing the benefit. I discussed this with my dentist and he will prescribe a different oral rinse.

Most voted negative review

13 People found this comment helpful

This was swabed on me before surgery, after surgery and during the night, I couldn’t sleep, I felt sick with nausea, pain in my head and stomach cramps. There was quite an amount the surgeon painted on my back and arm. 8 hrs after the operation I thought this could be the cause for my symptoms, and immediately washed it off. Within 1/2 an hour my symptoms had gone. It could even be a reaction of . ..

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Condition: Mouth Infection Prevention EffectivenessEase of UseSatisfaction

Be very careful before using this rinse. I had a severe allergic reaction after only 3 rinses. I spent 4 days in the hospital on several strong medications with an intravenous in both hands.

ShapeCreated with Sketch.thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Inflammation of the Gums EffectivenessEase of UseSatisfaction

I have periodontis and would brush and floss regularly but my gums would still bleed. I tried other mouthwashes and nothing helped. This was prescribed and I was afraid to use it because of the staining it said you might get. I eventually used it and it has helped tremendously. I only have a one tooth that bleeds a tad occasionally and when I went to the dentist and they probed me, no bleeding. That was unheard of for me. I actually go for cleanings every 3 months thats how bad my bleeding was. I get slight staining on the corners of my teeth and a slight build up of tartar. I noticed a canker sore every now and then but they never fully develop or last long. The taste is not bad at all and i think my tongue is a litte darker but for me the results outweigh the minor problems. Read More Read Less

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I have Sjogrens Syndrome and with loss of teeth due to no saliva production the microbiotic properties of CHX works very well. When I get sores inside my mouth they disappear usually overnight. I swear by this product and I have been using this for the past ten years. Its awesome.

3 ShapeCreated with Sketch. thumb_up copy 5Created with Sketch.Report this postFill 3Created with Sketch. Condition: Inflammation of the Gums EffectivenessEase of UseSatisfaction

Used it 20 yrs with irrigator and diluted 10 to one.

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I was prescribed this drug under the label name Acclean by my dentist after a deep cleaning procedure. After the 2nd use I experienced an itchy hive like rash bump on the outside of my mouth where maybe a slight drop touched and I noticed a slight redness and swelling on the left and right corners of my lower lip along with a slight numb tingling feeling.I rinsed my mouth with water 45 minutes after use and applied cold water repeatedly to the rash area. This extreme type of reaction after only 2 rinses is absolutely unacceptable for me. I was feeling fine with no mouth pain or rash prior to the rinse treatment. I am also in basically good health. I will NOT use this product again. I shudder to think what might happen to me in 6 days let alone 6 weeks. Please let the user beware. It’s the weekend however I will report this to my dentist on next week and have this reaction added to my medical records at my doctor office when I go for my annual visit. One last thing the taste of the product remains in my mouth one hour 20 minutes now even after rinsing with clear water. Users may want to know this too. Read More Read Less

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I had an ulcer in one nostril for over three years. It bled often. Nothing touched it. Then I tried Paroex that was prescribed for my husband. I swabbed my nostril with a Q-tip dipped in this stuff and in less than four days, it is healed! I am thrilled! Nice minty smell, too.

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have not been able to use it longer than a week..developed bad rash. anyone else?

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My tongue turned blackish brown…my ENT said this was the reason…how long will this stay on my tongue?

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When I went to the dentist last week, the hygienist noticed an ulcer in my mouth and asked me if I get them often. I have gotten them all my life and thought it was just a thing I had to deal with. The doctor gave me this mouthwash and it has tremendously helped my ulcers. If I get an ulcer and use this in the evening, by the morning time it is practically gone. If you have problems with ulcers, this may be something to ask your dentist about.

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Seems great. Did turn parts of my tongue brown black. That’s the only reaction. Was prescribed post sinus graft surgery.

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I use this as need for occasional mouth/gum sores. 3 or 4 days of use is generally enough. I always brush my teeth prior to use so have had no problems with staining.

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I bought Peridex fr my dentist and my mouth was constantly buring, so after 1 week I stopped taking it. It was for my periodontal disease. I was taking herbal mouth wash from Whole foods all natural. Will try something I saw on Amazon.

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This was swabed on me before surgery, after surgery and during the night, I couldn’t sleep, I felt sick with nausea, pain in my head and stomach cramps. There was quite an amount the surgeon painted on my back and arm. 8 hrs after the operation I thought this could be the cause for my symptoms, and immediately washed it off. Within 1/2 an hour my symptoms had gone. It could even be a reaction of my body absorbing the colour of the clorhexidine. It was definitely not a result of the surgery.

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My tongue is brow punish black. Dentist says just staining and common but no one else says that.

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Got my molar pulled and after 3 days my hard palate near the extraction site got wounded, perhaps the abscese was the cause. After 8 days, the site is healing well, but the wound was still there and was painful. I decided to use chlorhexidine twice a day (morning and night). After 2 days, the wound no longer that painful, and the redness was decreasing. So happy with this product, very effective. 🙂

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Prescribed by the dentist after a dental implant. Taste is fine (do not swallow), but teeth are now stained dark brown after 2 weeks use.

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After dental implant surgery, chlorhexidine gluc. was prescribed. Surprised at all the reported side effects since I had none. Not an unpleasant taste in my opinion and very effective at killing germs (which may of course cause an infection with newly sliced gums). Leaves you with a very clean-tasting mouth. One evening, I had a bad sore throat, not just a tickle, but instead painful just to swallow. Instead of just rinsing, I gargled with chorhexidine, right before bed. When I woke up, no soar throat…absolutely amazing. Where has this stuff been all my life? Read More Read Less

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I am now realizing that this medicine may have caused all the proplems I am having in my mouth along with losing my taste.

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Chlorhexidine gluconate was used to disinfect (I guess) my skin (vulva and rectum) prior to an outpatient procedure. Following the procedure I experienced severe burning and redness where the drug had been applied. The doctor attributed the reaction to the drug rather than anything related to the medical procedure. Other than the sensitivity I experienced, the drug was “effective.”

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NIHR Evidence – Chlorhexidine mouthwash is useful short-term for people with mild gum disease

In people with mild gum disease chlorhexidine mouthwash, in addition to tooth brushing, reduces plaque build-up in the first weeks or months of use. However, when used for longer than four weeks chlorhexidine mouthwash can lead to tooth staining and a build-up of chalky deposits on the teeth, called tartar. There is insufficient evidence to assess its effectiveness in people with moderate to severe gum disease.

Plaque is a sticky bacteria-filled substance that forms on teeth and can cause gum disease, resulting in sore, bleeding gums, infections and even tooth loss. Chlorhexidine is an antiseptic which kills most bacteria. In the UK chlorhexidine mouthwashes are licensed for 30 days’ use and are not recommended for routine use.

This systematic review suggests that chlorhexidine mouthwash may be considered as an addition to usual care for people with mild gum disease. There is scope for further investigation of the role of chlorhexidine in moderate to severe gum disease.

Why was this study needed?

Dental plaque is a sticky substance containing bacteria that builds up where the teeth meet the gums. Some of the bacteria in plaque can be harmful to teeth and gums, leading to gum disease (gingivitis).

The symptoms of gum disease are sore and swollen gums that can bleed during tooth brushing or flossing, and bad breath. Untreated gum disease can lead to receding gums and gum abscesses, potentially causing loose teeth or even tooth loss. The easiest way to prevent gum disease is to maintain good oral hygiene through regular tooth brushing, flossing and regular dental check-ups.

Chlorhexidine is an antiseptic used in a variety of ways, including disinfecting skin before operations and cleaning wounds. This review explored whether chlorhexidine reduced gum disease, prevented plaque or slowed development of tartar (chalky deposits on the teeth).

What did this study do?

This Cochrane systematic review included 51 randomised controlled trials, including 5,345 people. The studies involved people brushing their teeth, either with or without using floss or other interdental brushes to clean between teeth, and professional tooth cleaning. To this dental hygiene regime was added chlorhexidine mouthwash, a placebo mouthwash or no mouth rinsing.

Fifty out of 51 studies were judged to be at high risk of bias; the other study had an unclear risk of bias. The main source of bias was around not concealing which treatment people received from them and those assessing their gum disease. There were high drop-out rates from studies, a risk of selective reporting and substantial differences between the studies. Despite these risks of bias, the authors feel that the consistency of results mean that we can have confidence in their findings.

What did it find?

• Chlorhexidine mouthwash reduced mild gum disease (less than 1 on a gum disease scale of 0 to 3) by an average of ‑0.21 after four to six weeks (95% confidence interval [CI] ‑0.31 to ‑0.11) and by ‑0.20 after six months (95% CI ‑0.30 to ‑0.11). There was insufficient evidence to draw conclusions about the effectiveness of chlorhexidine in people with moderate to severe gum disease (scoring 1.1 to 3).
• Using chlorhexidine moderately reduced gum bleeding at four to six weeks (standardised mean difference [SMD] ‑0. 56, 95% CI ‑0.79 to ‑0.33) and six months (SMD ‑0.72, 95% CI ‑1.02 to ‑0.42).
• Plaque was assessed using various tools including the Plaque Index and the Turesky modification of the Quigley Hein Index. All indicated that chlorhexidine use had a large effect in reducing plaque at four to six weeks (SMD ‑1.45, 95% CI ‑1.90 to ‑1.00) and at six months (SMD ‑1.59, 95% CI ‑1.89 to ‑1.29).
• Levels of tartar were higher amongst people using chlorhexidine. Tooth staining was also significantly increased among people using chlorhexidine at four to six weeks, seven to 12 weeks and six months.
• There was insufficient data to draw conclusions about whether the frequency or concentration of chlorhexidine affected any of the studied outcomes.

What does current guidance say on this issue?

NICE’s Clinical Knowledge Summary service recommends that tooth brushing and interdental cleaning are used to remove plaque. Mouthwashes are not recommended for routine gum disease treatment because they do not act on established plaque and do not stop gum disease from progressing. The British Society of Periodontology and the Scottish Dental Clinical Effectiveness Programme suggest that chlorhexidine mouthwashes may be helpful to control plaque in the short term when mechanical cleaning is painful. In the UK, chlorhexidine mouthwashes are only licensed for 30 days’ use.

What are the implications?

Combining tooth brushing and cleaning with chlorhexidine mouthwashes reduces plaque build-up, compared to tooth brushing and cleaning alone.

However, using chlorhexidine mouthwashes for longer than four weeks leads to tooth staining (requiring professional cleaning) and a build-up of tartar. This supports UK guidance and licensing, which already restricts chlorhexidine mouthwash use to 30 days at a time.

Healthcare professionals should discuss the likely benefits, limitations and risks of using chlorhexidine mouthwashes in addition to tooth brushing and cleaning in people with mild gum disease. They should also point out that they do not replace flossing and regular dental hygienist visits for tartar removal.

Citation and Funding

James P, Worthington HV, Parnell C et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017;3:CD008676.

Cochrane UK and the Oral Health Cochrane Review Group are supported by NIHR infrastructure funding. The review was also funded by the Cochrane Oral Health Global Alliance and Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, UK.

Bibliography

BSP. The good practitioner’s guide to periodontology. London: British Society of Periodontology; 2016.

CKS. Scenario: gingivitis and periodontitis. London: National Institute for Health and Care Excellence; updated 2016.

NHS Choices. Gum disease. London: Department of Health; updated 2016.

SDCEP. Prevention and treatment of periodontal diseases in primary care dental clinical guidance. London: Scottish Dental Clinical Effectiveness Programme; 2016.

Produced by the University of Southampton and Bazian on behalf of NIHR through the NIHR Dissemination Centre

Chlorhexidine: antiseptic and disinfectant used for mouth ulcers, throat infections and skin infections

If you buy a chlorhexidine treatment in a pharmacy or supermarket, follow the instructions that come with it. For prescription medicines, follow the advice from your doctor, dentist or a pharmacist.

Wash your hands before and after using chlorhexidine. Keep it away from your eyes and ears. If chlorhexidine gets into your eyes or ears, rinse well with water.

Dosage and how to use lozenges

The usual dose for children aged 12 and older is up to 5 lozenges a day. Adults can have up to 10 a day.

Put a lozenge in your mouth and let it melt slowly.

Wait at least 30 to 60 minutes before having something to eat or drink.

Dosage and how to use mouthwash

The usual dose is 10 ml, twice a day.

Pour 10ml into the measuring cup. Rinse the mouthwash around your mouth for about 1 minute. Spit out the mouthwash, do not swallow it.

Wait at least 30 to 60 minutes before having something to eat or drink.

Dosage and how to use mouth spray

The usual dose is 2 squirts at a time, up to 12 times a day.

Aim the spray onto your affected tooth, gum, ulcer or the sore part of your mouth.

Wait at least 30 to 60 minutes before having something to eat or drink.

Dosage and how to use throat spray

The usual dose is 3 to 5 squirts. You can repeat this dose up to 10 times a day.

Wait at least 30 to 60 minutes before having something to eat or drink.

How to use dental gel

You’ll usually use the gel once or twice a day.

Put a small amount of gel onto your fingertip or a cotton bud. Gently wipe it across the surface of your mouth ulcer, gum or the sore part of your mouth.

Wait at least 30 to 60 minutes before having something to eat or drink.

How to use sore throat treatments

Only use chlorhexidine lozenges and sore throat spray for a short time. Do not keep using them continuously.

Contact a doctor if your symptoms do not improve after 3 to 4 days.

How to use dental treatments

Use your dental treatment at a different time of day to when you brush your teeth. This is because toothpaste can stop chlorhexidine working properly.

If you cannot use it at a different time, then rinse your mouth thoroughly with water after brushing your teeth. Wait at least 5 minutes before using chlorhexidine.

If your symptoms do not improve after one week, or if they get worse at any time, stop using chlorhexidine and contact your dentist or doctor.

Chlorhexidine skin treatments

Keep chlorhexidine skin treatments away from your eyes and mouth.

Skin treatments are usually used short-term for a few weeks, but occasionally you may have to use them for longer.

You can use treatments like Dermol lotion as both a body wash (soap substitute) and moisturising skin lotion.

How to use skin cream or lotion

Apply a thin layer of chlorhexidine cream or lotion to the affected areas of your skin. Follow the directions included in the packet.

How to use chlorhexidine as soap substitute or wash

Use your chlorhexidine treatment instead of soap or shower gel when you wash. You use it in the same way as an ordinary soap or gel. However, it may not be as foamy.

Be careful not to slip in the bath or shower, or on a tiled floor, when using the cream or lotion.

If you are going into hospital, you may be sent a chlorhexidine product to wash with before you come into hospital to reduce the chances of infection. This should come with instructions on how to use it.

What if I forget to use my chlorhexidine treatment?

If you forget your chlorhexidine dental or sore throat treatment, use it as soon as you remember, unless it’s nearly time for your next dose. In this case, just skip the missed dose and have your next one as normal.

If you forget to use your chlorhexidine skin treatment, that’s okay. Just start your routine again after the missed treatment and carry on as before.

If you have been prescribed chlorhexidine and forget to take it or apply it on a regular basis, it may help to set an alarm to remind you. You could also ask your pharmacist for other ways to remember your medicine.

What if I use too much?

Chlorhexidine is usually a safe medicine if you follow the instructions that come with it. However, do not use more than the recommended dose.

Speak to your doctor or a pharmacist now if you or your child has swallowed too much.

FDA Drug Safety Communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate

The U.S. Food and Drug Administration (FDA) is warning that rare but serious allergic reactions have been reported with the widely used skin antiseptic products containing chlorhexidine gluconate. Although rare, the number of reports of serious allergic reactions to these products has increased over the last several years. As a result, we are requesting the manufacturers of over-the-counter (OTC) antiseptic products containing chlorhexidine gluconate to add a warning about this risk to the Drug Facts labels. Prescription chlorhexidine gluconate mouthwashes and oral chips used for gum disease already contain a warning about the possibility of serious allergic reactions in their labels.

Patients and consumers should stop using the product that contains chlorhexidine gluconate and seek medical attention immediately or call 911 if they experience symptoms of a serious allergic reaction. These reactions can occur within minutes of exposure. Symptoms include wheezing or difficulty breathing; swelling of the face; hives that can quickly progress to more serious symptoms; severe rash; or shock, which is a life-threatening condition that occurs when the body is not getting enough blood flow.

Health care professionals should always ask patients if they have ever had an allergic reaction to any antiseptic before recommending or prescribing a chlorhexidine gluconate product. Advise patients to seek immediate medical attention if they experience any symptoms of an allergic reaction when using the products. Consider using alternative antiseptics such as povidone-iodine, alcohols, benzalkonium chloride, benzethonium chloride, or parachlorometaxylenol (PCMX) when any previous allergy to chlorhexidine gluconate is documented or suspected.

Chlorhexidine gluconate is mainly available in OTC products to clean and prepare the skin before surgery and before injections in order to help reduce bacteria that potentially can cause skin infections. These products are available as solutions, washes, sponges, and swabs and under many different brand names and as generics (see Facts about Chlorhexidine Gluconate). Chlorhexidine gluconate is also available as a prescription mouthwash to treat gingivitis and as a prescription oral chip to treat periodontal disease. In 1998, we issued a Public Health Notice to warn health care professionals about the risk of serious allergic reactions with medical devices such as dressings and intravenous lines that contain chlorhexidine gluconate.

We identified 52 cases of anaphylaxis, a severe form of allergic reaction, with the use of chlorhexidine gluconate products applied to the skin. In the 46 years between January 1969 and early June 2015, FDA received reports of 43 cases worldwide.* More than half of the 43 cases were reported after 2010, and after our 1998 Public Health Notice. This number includes only reports submitted to FDA, so there are likely additional cases about which we are unaware. The serious allergic reaction cases reported outcomes that required emergency department visits or hospitalizations to receive drug and other medical treatments. These allergic reactions resulted in two deaths. Eight additional cases of anaphylaxis were published in the medical literature between 1971 and 2015,^1-3 and one case was identified in the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance (NEISS-CADES) database between 2004 and 2013.

We urge patients, consumers, and health care professionals to report side effects involving chlorhexidine gluconate or other medicines to the FDA MedWatch program, using the information in the “Contact FDA” box at the bottom of the page.

*The cases were reported to the FDA Adverse Event Reporting System (FAERS).

Chlorhexidine use in adult patients on ICU

CHG for skin preparation prior to invasive procedures

According to international recommendations CHG > 0.5% ( w/v) in alcohol is the most efficacious antiseptic for skin preparation prior to invasive procedures in patients [4,5,6,7]. Strong clinical evidence suggests that 2% (w/v) CHG in 70% (v/v) isopropyl alcohol for skin antisepsis prior to placement of any short-term arterial, central, and hemodialysis catheters in patients located on ICU reduces the risk of catheter-related infection in comparison to ≤ 0.5% (w/v) CHG or povidone-iodine in alcohol [7]. Similarly there is evidence that the use of CHG as a skin preparation prior to venipuncture for blood cultures will reduce contamination rates [4,5,6]. It would therefore seem appropriate to use the CHG for all types of skin preparations prior to invasive procedures.

CHG dressings

Both CHG-impregnated sponges and CHG–gel dressings have been used for the care of indwelling intravascular devices and have resulted in an up to 60% decrease in the risk of arterial and CVC infections, including catheter-related bloodstream infections (CR-BSI) [8, 9]. Their use has been recommended in high-risk adult patients when the risk of infection remains high despite the application of an appropriate catheter care bundle. These CHG-containing dressings have, however, been associated with contact dermatitis in adults.

CHG-impregnated CVC

A meta-analysis of five randomized controlled clinical trials evaluating CVC with CHG–sulfadiazine on both the internal and the external surfaces has shown the risk of CR-BSI to be significantly reduced in comparison to standard CVC [OR = 0.51 (0.56–1.00)] [10]. However, this analysis found significant heterogeneity between investigations. More importantly, the pooled level of CR-BSI in the control groups was unacceptably high in two studies (7.2% and 14%). These factors make universal application of these antimicrobial catheters for all patients in all situations less clear. However, the use of CHG–silver sulfadiazine catheters seems appropriate when the background rate of CR-BSI is greater than 1 per 1000 catheter-days despite adherence to a comprehensive infection prevention bundle strategy.

Universal skin decolonization with CHG

The use of CHG washcloths significantly reduces GPB but not GNB bacterial bloodstream infections [11]. Their use is, however, associated with an increased risk of infections caused by bacteria with reduced susceptibility to CHG [11]. This raises the concern of the development of CHG resistance that could limit its future use prior to invasive procedures. The implementation of universal skin decolonization with CHG warrants caution and further consideration. It should only be considered where there is, for example, evidence of spread of infections caused by multidrug-resistant bacteria.

Oral decontamination with CHG for ventilated patients

CHG use for oral care in ICU patients has been recently challenged despite previous consistent data showing the beneficial effect of CHG in preventing ventilator-associated pneumonia (VAP) [12]. Firstly, oral mucosa adverse events with 2% (w/v) CHG mouthwash in ICU are frequent but often transient. Adverse events described were erosive lesions, ulcerations, plaque formation (which are easily removed), and bleeding mucosa in 29 of 295 patients (9.8%) who received 2% (w/v) CHG [13]. Secondly, despite a decrease in the rate of VAP in cardiac surgery patients, recent meta-analyses suggested that oral CHG paradoxically increased the risk of death, which may have resulted from toxicity of aspirated CHG in the lower respiratory tract [14, 15]. Consequently, it remains unclear whether using CHG for oral care affects outcomes in critically ill patients and CHG should not be used until further data become available.

Chlorhexidine: Expanding the Armamentarium for Infection Control and Prevention | Clinical Infectious Diseases

Abstract

Health care-associated infections (HAIs) result in increased patient morbidity and utilization of health care resources. Rates of HAI are increasing despite advances in health care technology. Limited antimicrobial agents and a dry drug pipeline make novel prevention efforts critical. Chlorhexidine, an antiseptic solution that has been used worldwide since the 1950s, is a safe and effective product with broad antiseptic activity. Novel uses of chlorhexidine-containing products are being implemented to promote antisepsis and prevent bacterial colonization and infection. We review some of the many infection control applications of chlorhexidine in the battle against HAI, such as general skin cleansing, skin decolonization, preoperative showering and bathing, vascular catheter site preparation, impregnated catheter site dressings, impregnated catheters, and oral decontamination. As mandatory public reporting and pay for performance force infection control issues to the forefront, chlorhexidine-containing products may provide a vast armamentarium for the control and prevention of HAI.

Health care-associated infections (HAIs), the most common adverse events encountered by hospitalized patients [1], complicate the hospital course of up to 10% of people who are admitted to acute care hospitals. These often serious infections result in significantly increased patient morbidity, mortality, length of stay, and utilization of health care resources. As health care technology advances, ironically, so do rates of HAI. Novel uses of experienced products are being implemented to combat these challenging infections. Here, we review decades of experience with an increasingly popular antiseptic, chlorhexidine.

In this review, we focus on applications of chlorhexidine as an infection control tool to prevent HAI and present evidence for the use of chlorhexidine to decontaminate both people and devices (table 1). In addition, we address safety concerns, such as development of drug resistance and adverse drug reactions. Additional areas of needed research are addressed, highlighting high-risk populations that may benefit from chlorhexidine interventions but for whom data are currently lacking.

Table 1

Evidence supporting selected uses of chlorhexidine for infection control.

Table 1

Evidence supporting selected uses of chlorhexidine for infection control.

Spectrum of Antiseptic Activity and Antiseptic Resistance

Chlorhexidine is a topical antiseptic solution that has been used worldwide since 1954. Its use in children and adults has provided an excellent record of safety and efficacy for applications as diverse as hand washing, preoperative skin preparation, vaginal antisepsis, treatment of gingivitis, and body washes to prevent neonatal sepsis. Chlorhexidine gluconate is a water-soluble, cationic biguanide that binds to the negatively charged bacterial cell wall, altering the bacterial cell osmotic equilibrium. Chlorhexidine is commercially available at a variety of concentrations (0.5%–4%) and formulations (with and without isopropyl alcohol or ethanol), and certain chlorhexidine-containing products are available over the counter. Because chlorhexidine-containing products come in many formulations and concentrations, we use “chlorhexidine” in this review to encompass chlorhexidine-containing solutions. At low concentrations, chlorhexidine affects membrane integrity, but at high concentrations, cytoplasmic contents precipitate, resulting in cell death [42, 43]. Chlorhexidine (0.05% solution) has broad activity against gram-positive and gram-negative bacteria, facultative anaerobes and aerobes, yeasts, and some lipid-enveloped viruses, including HIV [4, 44]. Chlorhexidine is not sporicidal.

Although decreased susceptibility to chlorhexidine has been reported, it has not been convincingly shown to be associated with repeated exposure to chlorhexidine. Proposed mechanisms include drug inactivation, efflux, and decreased uptake. Vancomycin-resistant enterococci (VRE) and vancomycin-susceptible enterococci, for example, have equivalent susceptibilities to chlorhexidine [45]. Some Pseudomonas species and other nonfermenting Gram-negative organisms have high-level resistance to chlorhexidine [46]. Plasmid-mediated resistance mechanisms to antiseptics are documented for staphylococci, as are increased MICs [43]; however, the clinical significance of these increased MICs has not been determined, because they are usually far less than the commonly used chlorhexidine concentrations. Decreased susceptibility and the potential for emergence of resistance exist. Several laboratory studies have raised concerns that emergence of biocide nonsusceptibility may result in cross-resistance to antibiotics, but data are limited [47]. As antiseptics become used more broadly, surveillance of clinical isolates should be considered to identify an epidemiologically significant trend toward decreasing antiseptic and antibiotic susceptibility.

Skin Antisepsis

General skin cleansing. Hand washing and skin antisepsis are now considered the most important interventions to prevent the spread of pathogens in hospitals. Use of chlorhexidine-based soaps and scrubs is supported by 25 years of clinical experience. Chlorhexidine rapidly reduces both skin flora and transient bacteria, such as Gram-negative bacteria. In the 1970s, hand washing with chlorhexidine was shown to reduce skin flora by 86%–92% [2, 3]. In addition, chlorhexidine has residual activity on the skin that helps to prevent rapid regrowth of skin organisms and enhances the duration of skin antisepsis. When surgeons used chlorhexidine hand scrubs, not only was there a greater reduction in the numbers of bacteria on the skin, compared with use of other antiseptic agents, but the bacterial count suppression was also maintained for up to 6 h [18, 48].

The spread of methicillin-resistant Staphylococcus aureus (MRSA) and other multidrug-resistant organisms in hospitals has become a major infection prevention and control focus, especially as community-associated MRSA strains have emerged as a cause of HAI. MRSA is known to colonize the skin and can be detected by skin culture in 8% of healthy adults [49] and 8%–44% of patients admitted to the intensive care unit (ICU) [50, 51]. MRSA, like other hospital-acquired, multidrug-resistant organisms, is presumed to be transmitted from patient to patient in the ICU on the hands of health care workers. Historically, most infection control measures have focused on asepsis of health care providers and the environment. Increasingly, however, decolonization and decontamination of colonized patients is being evaluated.

Colonization with MRSA in adult ICU patients is known to increase the likelihood of subsequent MRSA infection [52]. Whether decolonization is an effective intervention to prevent subsequent infection remains to be shown, and current Centers for Disease Control and Prevention (CDC) guidelines do not recommend routine decolonization as a standard infection prevention intervention [53]. However, decolonization is often considered for hospitalized patients in units with high colonization pressure, a known risk factor for MRSA transmission in hospitals [54]. Whole-body washing with chlorhexidine can reduce skin colonization [5], but eradication of S. aureus colonization has been achieved only in combination with nasal mupirocin [9], and the addition of doxycycline and rifampin may enhance decolonization efforts in hospitalized patients [10]. Chlorhexidine has been used to control outbreaks of S. aureus infection [12, 13]. Several investigators have used chlorhexidine and intranasal mupirocin to effectively decolonize MRSA carriers in ICUs with a high MRSA prevalence [55, 56]. The combination of intranasal mupirocin and chlorhexidine baths has been shown to reduce the incidence of nosocomial MRSA infection among ICU patients [11].

Whether chlorhexidine baths alone can reduce MRSA infection remains unknown. However, recent evidence suggests that decontaminating ICU patients with daily chlorhexidine baths may reduce transmission of other multidrug-resistant organisms and prevent HAI. Daily bathing of ICU patients with chlorhexidine decreased skin and environmental contamination with VRE and reduced the incidence of VRE acquisition (risk ratio [RR], 0.4; 95% CI, 0.1–0.9) in a comparison of the intervention period with 2 periods of bathing involving baths that did not contain chlorhexidine [6]. Not only did the intervention lead to decreased colonization of VRE on the skin of patients, but also fewer health care workers’ hands were contaminated with VRE. Evidence is mounting that daily bathing of ICU patients with chlorhexidine may also reduce HAI. A recent multicenter study evaluated daily bathing of adult ICU patients with chlorhexidine and found a 32% decrease in the acquisition of MRSA colonization (P<.05), a surrogate for health care-associated transmission of MRSA. VRE acquisition decreased by 30% (P<.01), and the incidence of all bloodstream infections (BSIs) decreased by 21% (P<.05) [7]. This study evaluated a before-and-after intervention, and additional studies will be needed to confirm these promising results. Although there is growing literature evaluating the use of chlorhexidine baths for patients with recurrent MRSA abscesses and other infections with community-associated MRSA strains, further research is needed in this important area.

Preoperative bathing and surgical site preparation. Early studies demonstrated the utility of chlorhexidine-based soaps and hand scrubs; a natural extension of use of this agent lies in the field of preoperative baths and skin preparation for surgical patients. Postoperative surgical site infections (SSIs) are frequently caused by a patient’s own skin flora, including those microorganisms that colonize body sites other than the surgical site. Similar to hand washing with chlorhexidine, chlorhexidine whole-body bathing significantly reduces microbial burden on the skin [14], and repeated baths lead to a progressive reduction of organisms over time [15]. Preoperative bathing and scrubbing with chlorhexidine is superior to preoperative bathing and scrubbing with povidone-iodine in reducing skin colonization at the site of surgical incision [57]. Preoperative baths are widely encouraged in clinical practice. Although we expect that decreasing general skin contamination in preoperative patients will decrease the number of SSIs, a clear cause-and-effect relationship has not been established to date. A recent Cochrane systematic review identified randomized, controlled trials of full-body bathing or showering with chlorhexidine, compared with placebo or regular soap, and found no clear evidence that preoperative bathing with chlorhexidine was more effective at reducing surgical site infections [16, 17]. Some of these studies entailed full-body rinsing after application of chlorhexidine, and this may have impacted chlorhexidine’s antiseptic activity, so conclusions about preoperative bathing should be interpreted with caution.

Chlorhexidine- and iodine-containing compounds are frequently used to prepare the skin immediately before surgery because of both agents’ utility in reducing skin microorganisms. After a single application, chlorhexidine achieves greater reduction in skin flora and has longer residual activity than does povidone-iodine [18, 19]. Chlorhexidine, unlike the iodophors, is active even in the presence of blood or serum proteins. There is extensive data demonstrating the reduction in skin flora resulting from use of these products, but again, there is no clear comparison demonstrating superiority of either of these products in reducing SSIs [4]. The benefits of chlorhexidine skin preparation are more evident when used in preparation for central venous catheter (CVC) insertion.

Insertion and Maintenance of Devices

Intravascular catheters are an integral component of 21st century medical care. The advantages of prolonged and secure venous access are counterbalanced by the added risks of infectious and noninfectious complications. Historically, in the United States, povidone-iodine has been used to prepare the skin for CVC insertion [58]. Current data, however, support chlorhexidine as the preferred agent for skin preparation before CVC placement.

The exact mechanism by which chlorhexidine reduces BSIs is unknown. For short-term catheters, skin organisms that colonize the catheter site are postulated to migrate along the catheter insertion tract and contaminate the catheter tip [59]. A multicenter study of neonates showed that skin preparation for peripheral intravenous catheter insertion with chlorhexidine reduced catheter colonization by 50%, compared with use of povidone-iodine [20]. This reduction of catheter colonization is postulated to decreased likelihood of developing a catheter-related BSI. In 1991, Maki et al. [60] reported that preparation of the CVC insertion site with chlorhexidine decreased BSI rates, compared with preparation with 70% alcohol or 10% povidone-iodine. In 2002, a meta-analysis reviewed 8 studies (involving 4143 catheters) found a 49% rate of reduction (RR, 0.51; 95% CI, 0.27–0.97) in the risk of catheter-related BSIs among patients whose skin was prepared with chlorhexidine [21]. The 2002 CDC’s “Guidelines for the Prevention of Intravascular Catheter-Related Infections” recognized the data supporting use of chlorhexidine for CVC placement and recommended a chlorhexidine-based preparation over tincture of iodine, an iodophor, or 70% alcohol for cutaneous antisepsis before CVC placement [61].

Chlorhexidine products are also used in the maintenance of indwelling catheters in attempts to prevent infectious complications. Catheter site colonization is postulated as the main portal of entry for bacteria that travel down the insertion tract and colonize the catheter tip [59]. To suppress microorganisms around the catheter insertion site, chlorhexidine-impregnated sponges are available that can be placed circumferentially around the catheter. Early studies compared these sustained-release chlorhexidine dressings with a transparent dressing in 2 university hospital ICUs. The treatment group had a reduced risk of catheter colonization (RR, 0.62; 95% CI, 0.49–0.78) and a lower rate of catheter-associated BSIs (RR 0.38; 95% CI, 0.16–0.89) [22], but these data remain unpublished. A multicenter trial involving 6 neonatal ICUs evaluated the impact of chlorhexidine-impregnated dressings on BSI rates and catheter colonization [23]; the study revealed that the neonates randomized to receive chlorhexidine-impregnated dressings were less likely to have colonized central catheter tips, compared with neonates whose catheter site care involved either povidone-iodine or 70% alcohol; however, both groups were equally likely to have a BSI (RR, 1.1; 95% CI, 0.8–1.5). A study of children who had undergone cardiac surgery revealed a significant reduction in catheter colonization among patients whose CVCs were maintained with a chlorhexidine-impregnated dressing, but again, there was no difference in the rates of BSIs [24]. The CDC’s “Guidelines for the Prevention of Intravascular Catheter-Related Infections” from 2002 made no recommendations regarding the use of chlorhexidine-impregnated dressings to reduce incidence of infection [61]. Although these data consistently find decreased colonization of CVCs, few published data demonstrate decreases in catheter-associated BSIs to support widespread use of chlorhexidine-impregnated dressing use. This is a promising area for further research.

Catheters and catheter cuffs can be impregnated or coated with antiseptics or antimicrobial agents. Coating of catheters with chlorhexidine in combination with silver sulfadiazine has been studied as a novel method to reduce catheter-associated BSIs. A meta-analysis from 1999 of randomized trials in which chlorhexidine- and silver sulfadiazine-impregnated CVCs were compared with nonimpregnated catheters revealed that use of catheters impregnated on the external lumen reduced the incidence of both catheter colonization and catheter-associated BSI [30]. A study of second-generation chlorhexidine- and silver sulfadiazine-impregnated CVCs, with coating on both the intra- and extraluminal sides, found decreased rates of catheter colonization, compared with the rates for standard catheters [31]. This study was not able to demonstrate a reduction in the number of catheter-associated BSIs, because it was underpowered. Chlorhexidine- and silver sulfadiazine-impregnated catheters are significantly more expensive than standard catheters; therefore, they are currently cost-effective only for select patient populations for whom BSI rates are high despite the use of appropriate infection control practices and insertion techniques [62]. The cumulative evidence regarding the efficacy of antiseptic-impregnated catheters in decreasing the rate of catheter-associated BSI is promising for high-risk patients, but other infection control interventions may be more cost-effective in areas with low rates of BSI and for low-risk patients.

Decontamination of the Oropharynx

In addition to skin cleansing, chlorhexidine is increasingly being evaluated for decontamination of the oropharynx. Chlorhexidine products effectively decontaminate the oropharynx and have been used for decades by dentists for controlling gingivitis and periodontitis. The applications of chlorhexidine in controlling oral infections is beyond the scope of this review, but we will point out that studies that have evaluated oral chlorhexidine rinses to decrease oral flora and prevent oral complications in bone marrow transplant recipients and other patients with malignancies have yielded mixed results [35, 36, 63].

Ventilator-associated pneumonia is a major cause of morbidity and mortality in patients hospitalized in intensive care units. Periodontal disease and poor oral hygiene have been correlated with nosocomial pneumonia [64]. Several investigators have studied the impact of chlorhexidine decontamination of the nasopharynx and oropharynx on prevention of HAI. These studies have yielded mixed results: some have shown a reduction in the incidence of ventilator-associated pneumonia [65], and others have shown no impact on rates of ventilator-associated pneumonia [66]. Segers et al. [34] specifically studied the incidence of HAI among patients undergoing elective cardiothoracic surgery. In this population, the authors found that perioperative decontamination of the oropharynx and nasopharynx with chlorhexidine was effective at reducing the absolute risk of postoperative HAI (risk reduction, 6.4%; 95% CI, 1.1%–11.7%). Patients in the treatment group had fewer lower respiratory tract infections and deep SSIs, but there was no significant reduction noted for the overall rate of SSI. A recent meta-analysis concluded from the available literature that, overall, chlorhexidine decontamination may reduce the incidence of ventilator-associated pneumonia by 30% [32]. The authors note that the benefits may be most significant for cardiac surgery patients undergoing coronary bypass grafting when the duration of postoperative intubation is shorter. The practice of oral decontamination for perioperative patients and ICU patients undergoing ventilation is highly variable. Questions still remain about cost-effectiveness, long-term safety, and the generalizability of the efficacy reported in the aforementioned studies.

Safety

For decades, chlorhexidine has been a well-tolerated, broadly used, skin and mucous membrane disinfectant. The most frequent adverse reaction to chlorhexidine is contact dermatitis (table 2), but rare cases of hypersensitivity and anaphylaxis have been reported [68]. Contact of chlorhexidine with the inner ear may result in permanent hearing loss [69]. In a rat model, direct application of chlorhexidine on neural tissue caused a dose-dependent degeneration of adrenergic nerves [71]. As a result, chlorhexidine for skin preparation before use of epidural catheters has not been routinely adopted for fear of damage to neural tissue; however, there are no clinical data to discourage the use of chlorhexidine for skin preparation before lumbar puncture, epidural catheter placement, or neurosurgical procedures.

Table 2

Known adverse effects of chlorhexidine.

Table 2

Known adverse effects of chlorhexidine.

Chlorhexidine is poorly absorbed through intact adult skin [72]. Since the 1970s, investigators have studied the efficacy of wiping or bathing neonates with chlorhexidine to reduce neonatal sepsis, and no significant adverse events have been reported [73–78]. A recent, comprehensive review concluded that some percutaneous absorption occurs at trace levels, particularly in preterm infants [79]; however, there have been no reports of adverse consequences as a result of chlorhexidine absorption in pediatric patients and no data to suggest that trace levels have clinical importance. Safety data for most chlorhexidine products have not been established in children (age, <18 years), so most chlorhexidine products have not been approved by the US Food and Drug Administration for such children. To our knowledge, no chlorhexidine product has been approved for children aged <7 years.

Conclusions

Historically, most infection prevention and control measures have focused on asepsis of health care providers and the environment. Emerging evidence for the role of host decontamination in preventing HAI is changing the paradigm and paving a new path for novel infection prevention interventions. Chlorhexidine has a long-standing track record of being a safe and effective product with broad antiseptic activity and little evidence of emerging resistance. As the limelight is directed toward control and prevention of HAIs, chlorhexidine-containing products may provide a vast tool kit for infection control practitioners. Increasing rates of multidrug-resistant bacteria, including MRSA and VRE, demand evidence-based research of novel interventions to prevent transmission of multidrug-resistant organisms and HAI. A delicate balance must be achieved between the rigorous regulatory oversight inherent in the traditional research model and the necessity for innovative quality-improvement initiatives, such that novel products can be tested in high-risk populations, including children. Given the promising preliminary studies discussed above, further research is essential to support evidence-based recommendations for the use of many chlorhexidine products in infection control and prevention.

Acknowledgments

Financial support. Pediatric Infectious Diseases Society Fellowship Award funded by an educational grant from AstraZeneca Pharmaceuticals (A.M.M.) and the CDC (UR8/CCU315092 to T.M.P.).

Potential conflicts of interest. A.M.M. has received grant support from Sage Products. T.M.P. has received grant support from Sage Products and 3M, serves on advisory panels for TheraDoc and Replidyne, and has given talks sponsored by Ortho-McNeil. C.L.P.: no conflicts.

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5 Ways to Prevent Chlorhexidine Staining

If you’re being treated for gum disease, have issues maintaining oral health, or are having certain dental procedures performed, your dentist might prescribe you a special antibacterial oral rinse containing chlorhexidine.

Chlorhexidine, short for chlorhexidine gluconate, is a compound that binds to the tooth surface and soft tissues of your mouth to block bad bacteria from forming there. It’s great for eliminating the types of bacteria that cause or worsen gum disease, and is also prescribed for people who need help controlling gum inflammation, plaque buildup, or need a sort of “deep clean” for their mouth—especially after intensive periodontal procedures such as tooth scaling and root planing.

Despite its many benefits, chlorhexidine does have a troublesome side effect: it can cause brown or yellowish stains on the teeth. It can be frustrating to improve the health of your teeth at the expense of their appearance, so follow these simple steps to help prevent chlorhexidine staining.

1. Brush and floss at least twice per day. This is a simple, but very important step. The easiest way to keep your teeth white is to practice good oral hygiene. Daily care prevents the buildup of bad bacteria, plaque, and tartar that can further discolor your teeth. Toothpastes that contain baking soda can help whiten your teeth, and flossing after each meal helps your whole mouth stay clean and healthy. Brushing with an electric toothbrush can also be very effective for polishing the plaque away.

Sometimes chlorhexidine is prescribed to patients who have a difficult time maintaining their oral hygiene and require a deep clean. Regular brushing and flossing will work toward maintaining the cleanliness and healthy look of your teeth after chlorhexidine.

2. Stop or minimize your coffee, tea, cola, red wine consumption. For the duration of the time you use chlorhexidine, make sure to minimize your intake of food and beverages that are likely to stain your teeth. Check here for a longer list of foods that could cause discoloration. If you are craving a drink that could stain your teeth, try to reduce the amount of contact by sipping it through a straw.

3. Don’t smoke. Tar and nicotine are some of the biggest causes of tooth discoloration out there. Smoking while using this mouthwash will only exacerbate the staining—plus, smoking is proven to have negative effects on your oral hygiene in general.

4. Ask your dentist for alternative antibacterial mouth washes or treatments if you have tooth crowns or caps made from composite or glass particles, as light-colored crowns and caps can stain easily.

5. Only use chlorhexidine for up to 2 weeks, unless otherwise prescribed by your dentist. Chlorhexidine mouthwash is not meant to be a permanent solution and your dentist will likely only prescribe it for 1-2 weeks to give your teeth, gums, and soft tissues a deep clean. Within the 2 week timeframe, the staining side effect shouldn’t be too severe as long as you brush and floss.

There are a thousand different tooth whitening products out there—toothpastes, oral rinses, strips, trays—but only your dentist will be able to recommend the best product or treatment for your particular teeth. If you have just undergone treatment for gum disease, it’s imperative that you consult your dentist before beginning any serious tooth whitening treatments. Your teeth might be extra sensitive following your treatment.

Some patients need professional whitening treatments, and some experience hardly any staining as a result of chlorhexidine mouthwash. It all depends on your mouth—and your oral hygiene. To learn more, contact us at My Family Dentistry to meet with Dr. Wes Mullins and our caring, experienced team.

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We’re so glad you’ve found My Family Dentistry, and we want you to get to know us! My Family Dentistry serving Powell and Knoxville, TN practices a uniquely comfortable dentistry approach to dental services.

Chlorhexidine – description of the ingredient, instructions for use, indications and contraindications

Description of chlorhexidine

Chlorhexidine is an antiseptic and disinfectant agent that is effective against bacteria that live on the skin and mucous membranes or in lesions on their surface. For external and local use only. Included in the WHO List of Medicines.

Physical and chemical properties of chlorhexidine

Chlorhexidine is a white crystalline powder.It melts at +137 ° C and is soluble in water. A solution based on it has an alkaline reaction.

Attention! The drug is available in the form of a solution, vaginal suppositories, patches, spray. The active ingredient can be present in ointments or gels. This is due to the fact that chlorhexidine is widely used to disinfect the skin and fight inflammatory processes in the dermis.

Pharmacological properties

Chlorhexidine is a powerful antiseptic. It is effective against vegetative gram-positive and gram-negative bacteria, yeast, Dermatophyte fungus and some viruses. The preparation disinfects skin, mucous membranes and lesions.

Advantages of the drug over other antiseptics:

• broad spectrum of activity – fights against viruses, fungi, bacteria;
• stimulation of metabolism in the dermis;
• acceleration of tissue healing;
• security;
• rare occurrence of adverse reactions;
• does not injure the skin;
• does not lose its effectiveness when mixed with purulent exudate.

Indications for the use of chlorhexidine

The drug is used for local treatment of wounds and injuries on the mucous membranes with erosion of the cervix, sore throat, aphthous stomatitis, periodontitis, gingivitis. Suitable for disinfection of wounds, burns on the skin.

Contraindications and side effects

Chlorhexidine is contraindicated in dermatitis, allergic processes and sensitivity to certain substances in the composition.It is not recommended to be used in combination with iodine. Do not treat conjunctivitis with a drug and rinse the cavities.

When using chlorhexidine, adverse reactions may develop. They differ depending on the form of release of the product:

• gel – dryness and discoloration of the skin, itching, dermatitis, hypersensitivity to ultraviolet light, the appearance of tartar, changes in taste, enamel staining;
• solution – itching, allergies;
• vaginal suppositories – itching, allergies.

Methods and rules of application

Chlorhexidine solutions are used for irrigation, applications and rinsing for stomatitis, gingivitis and other infectious lesions in the oral cavity. For this, a 0.5-th solution is applied to the infected area of ​​the skin or mucous membrane in an amount of 7-10 ml using a cotton swab or rinsed with it for several minutes. The procedure is carried out 3 times a day.

With the help of the drug, you can prevent the occurrence of sexually transmitted diseases.To do this, it must be used within two hours after contact with a suspected infected person. It is inserted into the urethra (men) or the vagina (women) using a nozzle and left for a few minutes. Additionally, all parts of the body adjacent to the genitals are treated with a solution. Do not shower for 2 hours after the procedure.

In the treatment of urethritis, a 0.005% chlorhexidine solution is injected into the urethra 2 times a day. The dosage is 3 ml.The duration of therapy is 10 days. The procedures are carried out every other day. Vaginal suppositories are used three times a day for 10–20 days.

The plasters are glued to the injured areas of the skin, having previously freed them from the protective film. The solution is applied to the skin by applying an application for 3 minutes.

90,000 Chlorhexidine skin treatment to prevent death and infection in newborns

Relevance

Infections are the most important cause of death in newborns worldwide and are responsible for nearly a third of all neonatal (newborn) deaths.Affordable, feasible and effective interventions are needed to reduce neonatal infections and improve neonatal survival. Chlorhexidine, a broad spectrum antiseptic, is active against common microorganisms that cause perinatal infections. The use of chlorhexidine on the newborn’s skin or on the umbilical cord, or in conjunction to prevent infection, is considered a possible strategy to improve neonatal survival. In this review, we evaluated the efficacy of chlorhexidine treatment for newborn skin or umbilical cord (cord care) versus routine or no treatment for newborn survival and infections in newborn infants born in hospital or at home (community).

Characteristics of research

We searched the medical literature for hospital and home studies that assessed the incidence of infection and death in infants who received either chlorhexidine care after randomization or standard practice. Searches were conducted up to November 2013. Twelve relevant studies were found: seven in hospitals and five in the home (community).Four studies performed maternal vaginal lavage with chlorhexidine in addition to skin and umbilical cord care in newborns. The duration of the included studies ranged from 6 to 37 months. The number of participants in the included studies ranged from 112 to 29,760. None of the included studies reported any conflicts of interest, and none were funded by pharmaceutical companies.

90,075 Key Outcomes 90,076

Newborn skin or umbilical cord treatment with chlorhexidine versus routine hospital care

Chlorhexidine cord treatment versus dry cord care may not result in any difference in neonatal mortality.However, chlorhexidine treatment of the umbilical cord is likely to reduce the risk of omphalitis or infections.

Chlorhexidine treatment of skin versus dry umbilical cord care may not result in any difference in the incidence of omphalitis or infections (none of the studies in this comparison reported the effect of treatment on neonatal deaths).

Newborn skin or umbilical cord treatment with chlorhexidine versus conventional home (community) care

Chlorhexidine umbilical cord treatment compared to dry cord care reduces neonatal mortality and the incidence of omphalitis or infections.There was no difference between chlorhexidine skin treatment and routine skin care for neonatal mortality (none of the studies in this comparison reported the effects of treatment on omphalitis or infections).

Use of chlorhexidine for maternal vaginal treatment in addition to general whole body treatment versus no intervention (sterile saline) in hospitals

Chlorhexidine treatment of the mother’s vagina in addition to total body treatment versus no treatment does not likely result in a difference in neonatal death and infection.Sanitation of the mother’s vagina, in addition to general treatment of the whole body, increases the risk of hypothermia.

Chlorhexidine for maternal vaginal treatment in addition to total body treatment versus no intervention (sterile saline) in the community (at home)

The use of chlorhexidine for maternal vaginal treatment in addition to total body treatment versus no intervention may not result in a difference in neonatal mortality.The use of chlorhexidine to treat the mother’s vagina in addition to general whole-body treatment versus no intervention appears to reduce the risk of neonatal infections (none of the studies included in this comparison reported an effect on omphalitis).

Quality of evidence

Confidence in assessing the effect (quality of evidence) for the effect of chlorhexidine on neonatal mortality and omphalitis or infection was variable (low, medium and high).Poor research performance and insufficient data were the main reasons for the decline in the quality of the evidence.

Comparative study of the antimicrobial activity of drugs used for antiseptic treatment of root canals of teeth

Due to the wide spread of pulp and periodontal diseases, endodontic treatment is of particular importance in modern dentistry [6, 8]. Endodontics deals with the treatment and prevention of dental caries complications. The modern level of dentistry has a number of features and is characterized by the emergence of new technologies, modern equipment and materials.

The prevalence of dental caries and its complications among the adult population of Russia is quite high – according to the literature, it ranges from 90 to 100% [11] in persons under 44; pulpitis and periodontitis account for at least 45-50% of all dental diseases, and the inflammatory process in the periodontium in persons over 50 is the reason for tooth extraction in more than 50% of cases. In recent years, certain successes have been achieved in the treatment of complications of caries (pulpitis and periodontitis), but this problem continues to remain far from a final solution.Insufficient efficiency of periodontitis treatment determines the tasks of finding new ways to solve this urgent problem and necessitates the development of new approaches to complex therapy [5, 9, 10].

The success of the treatment of pulpitis and periodontitis largely depends on the effectiveness of the impact on the microbial factor. The main condition for successful endodontic treatment is thorough mechanical and medical treatment of the carious cavity and root canal, which provides for the complete elimination of bacteria and their toxins [4].

Poor treatment of periodontitis is the cause of the development of the inflammatory process in at least 65% of patients with periostitis of the jaws, in 75% of patients with osteomyelitis, in 69% of patients with phlegmons of the maxillofacial region.

Literature data indicate the unsatisfactory quality of endodontic treatment at the general dental appointment: the filling depth was optimal only in 54% of the examined teeth, in 32% of cases the filling was incomplete, in 14% of cases there was an excessive removal of the filling material into the periodontium.Complete closure of the root canal system with a biocompatible material, provision of impermeability to bacteria is the main guarantee of termination of antigenic stimulation of periodontal tissues, creation of favorable conditions for reparative processes in the periapical zone and prevention of re-infection in the long term after completion of treatment [1, 3, 6].

The purpose of this study is to study the antimicrobial activity of antiseptic drugs that are used in endodontics for the treatment of root canals.

Material and methods

In the study, a solution of chlorhexidine bigluconate in 6 concentrations (2.0; 1.0; 0.5; 0.2; 0.1; 0.02%), 2 preparations based on sodium hypochlorite – Rarcan (France) and Hypochloran-3 (Russia), as well as a stabilized solution EDTA “Solutions” (Korea).

Working solutions of chlorhexidine were prepared by diluting a 20% solution. Parcan, Hypochloran-3 and EDTA “Solutions” were used ready-made.

Sample preparation and testing was carried out under aseptic conditions.

To determine the antimicrobial activity, control strains of microorganisms were used: Escherichia coli, Staphylococcus aureus, Candida albikans, Staphylococcus faecalis . The cultures were grown at a temperature of -37 ° C for 24 hours. For testing, they were diluted 1: 1000 with a sterile 0.9% sodium chloride solution.

1 ml of suspension of the test strain was placed on the agar surface of the nutrient medium.The cups were dried and wells with a diameter of 10 mm were made with a special punch. The test solution was added to the wells. The results were recorded after 24 hours by measuring the growth inhibition zone around the well.

Results and discussion

Chlorhexidine is an antiseptic agent that is active against vegetative forms of gram-positive and gram-negative microorganisms, fungi of the genus Candida , lipophilic viruses, Staphylococcus aureus, periodontopathogenic microorganisms.Depending on the concentration used, it exhibits a bacteriostatic or bactericidal effect. It can be used in different concentrations from 0.01 to 5% aqueous and alcoholic solutions.

This antiseptic is widely used in medicine in general and in dentistry in particular [3]. The action of chlorhexidine is based on the ability to be in long-term contact with negatively charged bacteria (it itself has a strongly pronounced positive charge), which leads to rupture of the cell membrane, which, under the influence of chlorhexidine, is unable to maintain the osmotic balance.

Chlorhexidine is widely used in endodontics for the treatment of root canals. However, there is evidence that dentin and dentin components, including collagen, significantly reduce, up to complete inhibition, its antimicrobial effect [12].

The results of determining the antimicrobial effect of chlorhexidine are presented in table . 1.

They indicate that the level of antimicrobial activity of chlorhexidine is directly proportional to its concentration: with its decrease, the zone of inhibition of the growth of microorganisms decreases.The highest activity of all tested chlorhexidine solutions in relation to E. coli , the least – to St. faecalis .

Minor differences in the antimicrobial effects of 0.2 and 0.1% chlorhexidine solutions were noted. When exposed to St. aureus and E. coli , the growth retardation zone was 28.0 and 30.0 mm, respectively. Despite the fact that the concentrations of the studied solutions differed by a factor of 100 (2.0% and 0.02% solutions), their activity in relation to all studied strains remained at a sufficiently high level even at a concentration of 0.02%.

Sodium hypochlorite (NaOCl) is a sodium salt of hypochlorous acid, contains 95.2% active chlorine, a very strong oxidizing agent. It has an antiseptic and disinfectant effect [2, 7]. NaOCl – is active due to the chlorite ion. NaOCl kills microorganisms quickly and at low concentrations. It is most active in a neutral environment. The decomposition of NaOCl is accompanied by the formation of a number of active species and, in particular, singlet oxygen, which has a significant biocidal effect.Some human cells, in particular, neutrophils, hepatocytes, etc., synthesize hypochlorous acid and associated highly active radicals to fight microorganisms and foreign substances. NaOCl has a pronounced effect on gram-positive and gram-negative microorganisms, fungi of the genus Candida , periodontal pathogenic microorganisms, and has antiviral properties, including against HIV, rotaviruses, herpes viruses and hepatitis A and B. Enterococci are most resistant to the action of sodium hypochlorite, especially – St.faecalis .

Sodium hypochlorite is widely used in endodontics as an antiseptic and irrigation solution.

The results of determining the spectrum of antimicrobial activity of drugs based on sodium hypochlorite are presented in table . 2.

The studies carried out have confirmed the high level of antimicrobial activity of sodium hypochlorite, which is higher than that of chlorhexidine. For example, in relation to Staphylococcus aureus, Hypochloran-3 is almost 1.5 times more active (the growth retardation zone is 38.0 and 52.5 mm, respectively).

The strongest antimicrobial effect of the Parcan preparation was determined in relation to E. coli (45.0 mm), the least in relation to St. faecalis (33.5 mm). Hypochloran-3 is most active against St. aureus . Effect on strain St. faecalis was slightly more pronounced than Parcan than Parcan. The data obtained in the course of the study are comparable with the literature data, especially the effect of hypochlorite on the strain St.faecalis .

EDTA “Solutions” is a disodium salt of ethylenediaminetetraacetic acid. It is used in dentistry to expand root canals. EDTA is able to form complex compounds with various positively charged ions. Data from the study of the antimicrobial effect of EDTA are presented in Table . 3.

The preparation for the treatment of root canals for the purpose of their expansion EDTA “Solutions” has a pronounced antimicrobial activity in relation to all tested strains.The largest zone of growth retardation was revealed when exposed to St. faecalis (48 mm).

The results of the study confirmed the high antimicrobial activity of chlorhexidine antiseptics and preparations based on sodium hypochlorite. The mechanism of the bactericidal action of EDTA has not been studied in this study, but the drug can be successfully used not only to expand the root canals of teeth, but also as an antiseptic.

Quantitative determination of 0.05% chlorhexidine solution by capillary electrophoresis

Zverkov, A.V., & Zouzova, A. P. (2013) Khlorgeksidin: nastoyashchee i budushchee odnogo iz osnovnykh antiseptikov [Chlorhexidine: Past, Present, and Future of the Famous Antiseptic Agent]. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya, 15 (4), 279–285. [in Russian].

Gerke, A. N. (2015) Osnovnye principy mestnoj antimikrobnoj terapii v dermatologii [The basis of topical antimicrobial therapy in dermatology]. VetPharma, 1 (23), 66-75. [in Russian].

Kasikhina, E.I. (2013) Hlorgeksidin: obzor lechebnykh vozmozhnostej i potencial’nykh klinicheskikh pokazanij v praktike akushera-ginekologa i venerologa [Chlorhexidine: a review of treatment options and potential clinical indications in the practice of an obstetrician] Akurshestvo i ginekologiya, 4, 4–9. [in Russian].

Pogosyan, M.A. (2015) Hlorgeksidin – antiseptik, ne privodyashchij k bakteriorezistentstnosti [Chlorhexidine is an antiseptic that does not lead to bacterioresistance].Byulleten ‘mededicinskih internet-konferencij, 5 (10), 1234-1235. [in Russian].

Kouzmina, E., Lapatina, A., & Smirnova, T. (2014) Opolaskivateli polosti rta s khlorgeksidinom: e’ffektivnost ‘i bezopasnost’ primeneniya (obzor literatury) [Efficacy and safety of chlorhexidine mouthrinses (literature review)]. Dental Forum, 2 (53), 34–39. [in Russian].

Kvashnina, D. V., & Kovalishena, O. V. (2016) Ocenka primeneniya khlorgeksidina kak antisepticheskogo sredstva [Evaluation of chlorhexidine application as an antiseptic].Medicinskij al’manakh, 3 (43), 62-66. [in Russian].

Dounar, H. G., & Rzheuski, S. E. (2017) Antimikrobnaya aktivnost ‘gelya hlorgeksidina biglyukonata, prednaznachennogo dlya lecheniya kandidoza treatment polosti rta [Antimicrobial activity of the gel with chlorhexidine digluconate oral intended for oralis intended for Vestnik Vitebskogo gosudarstvennogo

medicinskogo universiteta, 16 (3), 91–97. [in Russian].

Lin, S.-C., Huang, C.-F., Shen, L.-J. Wang, H.-J., Lin, Ch.-Y., et al. (2015) Formulation and stability of an extemporaneous 0.02% chlorhexidine digluconate ophthalmic solution. J. Formos. Med. Assos., 114, 1162-1169. https://doi.org/10.1016/j.jfma.2014.08.003

George, J., Klika, A. K., & Higuera, C. A. (2017) Use of Chlorhexidine Preparations in Total Joint Arthroplasty. J. Bone Jt Infect., 2 (1), 15-22. doi: 10.7150 / jbji.16934

Fiorentino, F.A. M., Corrêa, M. A. & Salgado, H. R. N. (2010) Analytical Methods for the Determination of Chlorhexidine: A Review. Crit. Rev. Anal. Chem., 40, 89-101. doi: 10.1080 / 104083402020

Tyzhigirova, V. V., & Timofeeva, O. N. (2017) Analiz lekarstvennykh preparatov khlorgeksidina biglyukonata i miramistina metodami UF-spektrofotometrii i tonkoslojnoj khromatografii [Analysis of drugs chlorhexidine bigluconate and mi-thin spectroscopy by chromatistine bigluconate and miramistina metodamiInnovacionnye tekhnologii v farmacii Proceedings of the All-Russian Scientific and Practical Conference with international participation, (P. 115–121). Sumy: IGMU. [in Russian].

Mubeen, R. S., Mantri, A. P., Singh, S. K., et al. (2016) Simultaneous estimation of chlorhexidine digluconate and miconazole nitrate by RP-HPLC. European Journal of Biomedical and Pharmaceutical Sciences, 3, 617-620.

Mohamme, T. G., & Abdel Aziz, E. M. (2017) Development and validation of a simple, fast, isocratic stability indicating RP-HPLC-UV method for the determination of chlorhexidine and its impurity para-chloroaniline in bulk and finished product.Journal of Pharmacy, 7, 01-08. doi: 10.9790 / 3013-0706010108

Bogdanovska, L., Saliu, S., Popovska, M., Dimitrovska, A., Ugrinova, L., & Petkovska, R. (2014) Development and validation of RP – HPLC assay of chlorhexidine in gingival crevicular fluid. Arh. farm., 64, 69–82. doi: 10.5937 / arhfarm1402069B

Siddiqui, M. R., AlOthman, Z. A., & Rahman, N. (2017) Analytical techniques in pharmaceutical analysis: A review. Arabian Journal of Chemistry, 10 (1), 1409-1421.https://doi.org/10.1016/j.arabjc.2013.04.016

Kumar, M., Bhatia, R., & Rawal, R. K. (2018) Applications of various analytical techniques in quality control of pharmaceutical excipients. J. Pharm Biomed Anal. 157, 122-136. https://doi.org/10.1016/j.jpba.2018.05.023

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Abramova, E., Alekseeva, N., & Egorov, A. (2012) Attestaciya / kvalifikaciya (validaciya) oborudovaniya i analiticheskikh metodov v farmacevticheskom proizvodstve [Instrumentation and Analytical Methods Attestation / Qualification (Validation) whenAnalitika, 1, 60–62. [in Russian].

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(2017). USP39-NF34. Rockville. Retrieved from http://www.usp.org/ sites / default / files / usp_pdf / EN / products / usp39-nf34-index-supplement1.pdf.

instructions for use, analogs, composition, indications

An antiseptic agent with a pronounced bactericidal effect against gram-positive and gram-negative bacteria (does not affect the acid-fast forms of the latter): Treponema pallidum, Chlamidia spp., Ureaplasma spp., Neisseria gonorrhoeae, Gardnerella vaginalis, Bacteroides fragilis, protozoa (Trichomonas vaginalis), microbial spores, viruses, fungi; weakly affects some species of Proteus and Pseudomonads. Chlorhexidine bigluconate is also active against treponemas, gonococci, Trichomonas. Remains active (somewhat reduced) in the presence of blood, pus. Cleans and disinfects the skin without causing damage.

The drug is used to prevent sexually transmitted diseases (syphilis, gonorrhea, trichomoniasis, chlamydia, etc.).
It is used for antiseptic treatment of wounds, abrasions and cracks, burns, bacterial and fungal diseases of the skin and mucous membranes, incl. in urology, surgery, obstetrics and gynecology.
In dentistry, it is used for rinsing the oral cavity in cases where it is difficult to comply with the rules of hygiene, in the postoperative period after flap operations on the periodontium, for washing periodontal pockets, fistulas, and abscess cavities. Since chlorhexidine digluconate has a cytotoxic effect, the concentration of the rinse solution should not exceed 0.25 mg / ml.

Allergic reactions (skin rash), dryness and itching of the skin, dermatitis, photosensitivity, stickiness of the skin of the hands (within 3-5 minutes), chemical burns of newborns (frequency unknown) are possible.In the treatment of gingivitis – staining of tooth enamel, tartar deposition, taste disturbance.
Reporting adverse reactions
If you have any adverse reactions, consult your doctor. This recommendation applies to any possible adverse reactions, including those not listed in the instructions for medical use.
You can also report adverse reactions to the information database on adverse reactions (actions) to drugs, including reports of drug ineffectiveness (UE Center for Expertise and Testing in Healthcare, rceth.by). By reporting adverse reactions, you can help provide more information on the safety of this medicine.

The bactericidal effect increases with increasing temperature.At temperatures above 100 ° C, the drug is partially decomposed. The contact of hypochlorite bleaching agents on fabrics that have previously been in contact with drugs containing chlorhexidine can contribute to the appearance of brown stains on them. In patients with open traumatic brain injury, spinal cord injuries, perforation of the tympanic membrane, contact with the surface of the brain, meninges and the inner ear cavity should be avoided. In case of contact with the mucous membranes of the eyes, they should be quickly and thoroughly rinsed with water.
Simultaneous use with iodine is not recommended.
Use in children. The use of chlorhexidine solution (water or alcohol) in newborns as a skin antiseptic before invasive procedures is associated with a certain risk of developing a chemical burn. Based on spontaneous reporting data and literature data, a higher risk of skin reactions was revealed in premature infants, especially those born before 32 weeks of gestation, in whom chlorhexidine was used during the first two weeks of life.
Before carrying out invasive procedures, it is necessary to remove all materials soaked in chlorhexidine: bandages, sheets, napkins, gowns, etc. Do not use excessive amounts of solution. Avoid the accumulation of solution in the skin folds, under the patient’s body, on materials that are in direct contact with the child’s skin.
If an airtight dressing (occlusive dressing) is to be applied to skin previously exposed to chlorhexidine, make sure that there is no excess chlorhexidine solution on the skin before applying the dressing.
Use in the elderly. There are no data concerning the peculiarities of use in elderly patients.

90,000 Chlorhexidine baths in critically ill patients to prevent hospital infections – Lewis, SR – 2019

Chlorhexidine baths in critically ill patients to prevent hospital infections

What is the purpose of this review?

The aim of this review was to determine whether chlorhexidine should be used as a bath antiseptic in critically ill patients in order to prevent the development of infections.Cochrane researchers collected and analyzed all relevant studies to answer this question and found eight relevant randomized clinical trials. Randomized trials are medical studies in which patients are randomly assigned to groups to receive different treatments. This study design provides the strongest evidence that treatment is associated with desired or unwanted health outcomes.

Key Information

This review assessed whether the use of chlorhexidine (instead of soap and water) when bathing patients in the ICU or ICU resulted in a decrease in the number of nosocomial infections.The evidence available from the studies we analyzed was of very low quality, meaning we cannot be confident that bathing with chlorhexidine reduces the likelihood of infection or death in critically ill patients. We are also not convinced that bathing critically ill patients with chlorhexidine will shorten hospital stay or reduce the risk of skin reactions.

What was learned in this survey?

People who are critically ill (in the intensive care unit or in the intensive care unit) often develop infections during their hospital stay.These infections can lead to increased length of hospital stay, additional medical complications, disability, or even death. Patients in the intensive care unit are especially vulnerable to developing these infections because their body’s ability to fight the infection is reduced due to illness or injury. Surgical tubes and lines (for example, to help with feeding or breathing) can make it easier for bacteria to enter the body. Chlorhexidine is an inexpensive drug used as an antiseptic and disinfectant in hospitals.

What are the main findings of this survey?

In December 2018, we searched for studies on the use of chlorhexidine in bathing critically ill patients. We found eight studies, dating from 2005 to 2018, involving a total of 24,472 people from over 20 intensive care units. Seven studies included adults and one study only included children. All studies included both men and women.All studies compared bathing with chlorhexidine and bathing with soap and water or non-antimicrobial washcloths. Four studies received funding from independent sponsors (government agencies, hospitals or university departments) or reported no external funding, and the other four studies received funding from companies that make chlorhexidine drugs.

Evidence from all eight studies is not sufficient to ensure that patients who are using chlorhexidine for bathing are less likely to develop infections during their ICU stay.We are also not sure if the likelihood of death in patients who use chlorhexidine for bathing is less, as the certainty of the evidence from the six studies reporting this is very low. We did not combine evidence from six studies that reported length of stay in the intensive care unit, as the results were very different. We are also not convinced that the length of stay in the intensive care unit for patients receiving chlorhexidine bathing was shorter because the certainty of the evidence is very low.Five studies reported varying evidence as to whether chlorhexidine use resulted in more or fewer skin reactions. We are not sure if patients using chlorhexidine baths are less or more likely to have skin reactions, as the certainty of the evidence is very low.

Quality of Evidence

Most studies did not use methods to disguise the type of bathing solution used by staff, increasing the risk that staff may have treated patients differently depending on whether they were in the chlorhexidine study group or in the study group using soap and water.Participants in some studies may have already had an infection before the study began, and we had concerns that this might affect our results. We also noticed significant differences in some outcomes, and there were very few reports for some outcomes. For these reasons, we rated the quality of this evidence as very low.

How relevant is this review?

We searched for studies published up to December 2018.

(PDF) Use of chlorhexidine for the prophylaxis of nosocomial infections in ICU

Chlorhexidine in the prevention of nosocomial infections in ICU

Bagin V.A. et al.

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